Calcium hydroxylapatite (CaHA), marketed as Radiesse®, is a biostimulatory dermal filler recognized for its dual ability to restore facial volume and stimulate collagen production, resulting in both immediate and long-term improvements in facial aesthetics. At Cosmetic Injectables Center Medspa, all CaHA procedures are performed by certified expert injectors under the direct supervision of Dr. Sherly Soleiman, MD, a board-certified physician and national leader in nonsurgical medical aesthetics.
What Is Calcium Hydroxylapatite (Radiesse®)?
Radiesse® is composed of 30% CaHA microspheres (25–45 μm) suspended in a 70% carboxymethylcellulose (CMC) gel carrier. This formulation provides immediate volumizing effects upon injection, while the CaHA microspheres act as a scaffold for new collagen, elastin, and extracellular matrix (ECM) production. The gel carrier is absorbed within weeks, leaving behind the microspheres to stimulate tissue regeneration for up to 12–18 months (FDA Summary, 2015).
Mechanism of Action: Collagen Stimulation and Tissue Regeneration
Radiesse® works through mechanotransduction, where the physical presence of CaHA microspheres activates fibroblasts, leading to:
- Neocollagenesis: Up to 160% increase in types I and III collagen, confirmed by histological studies (Frontiers in Medicine, 2023).
- Neoelastogenesis: Enhanced elastin synthesis, improving skin elasticity.
- Angiogenesis: Promotion of new blood vessel growth, supporting healthy skin.
- Proteoglycan Production: Improved hydration and dermal smoothness.
Compared to other biostimulatory fillers like Sculptra® (poly-L-lactic acid), CaHA offers a faster onset of effects and lower immune cell recruitment (ASJ, 2018).
Clinical Applications and FDA Approvals
Approved Indications
- Facial wrinkles and folds: Approved by the FDA in 2006 for moderate-to-severe facial wrinkles, including nasolabial folds (FDA, P050037).
- HIV-associated lipoatrophy: Approved for facial volume loss in HIV patients.
- Hand augmentation: FDA expanded approval in 2015 for correction of volume loss in the dorsum of the hands (FDA, P050052S049).
Off-Label and Emerging Uses
- Hyperdiluted Radiesse®: Used in diluted form (1:3 to 1:6) for skin tightening and superficial biostimulation in areas like the neck and décolletage (PRS Global Open, 2019).
- Burn scar improvement: Recent pilot studies show biomechanical improvements in scarred skin (ScienceDirect, 2025).
- Panfacial rejuvenation: Multilayered protocols using various dilutions for balanced, natural results (ASJ Open Forum, 2024).
Common Treatment Areas
- Nasolabial folds
- Marionette lines
- Cheeks and midface
- Jawline and chin
- Temples
- Hands
- Neck and décolletage (hyperdiluted)
For a detailed overview of Radiesse® procedures, visit our Radiesse® procedure page.
Clinical Evidence: Efficacy and Longevity
Patient Satisfaction and Outcomes
| Outcome Measure | Facial Areas (%) | Nonfacial Areas (%) | Key Reference |
|---|---|---|---|
| Patient Satisfaction | 98 (91–99) | 90 (67–97) | Meta-Analysis, 2024 |
| GAIS Patient Improvement | 89 (76–96) | 94 (75–99) | Meta-Analysis, 2024 |
| GAIS Injector Improvement | 92 (33–100) | 95 (1–100) | Meta-Analysis, 2024 |
- Longevity: Clinical effects last 12–18 months, with some histological evidence of ongoing collagen production beyond visible correction (JCAD, 2008).
- Dermal Thickness: Increases of up to 210 μm at 90 days post-injection (PMC12193805, 2025).
- Skin Quality: Improvements in elasticity, hydration, and texture, especially with hyperdiluted protocols.
Recent Clinical Trials and Studies
- Facial Burn Scars: Subdermal CaHA improved skin extensibility, elasticity, and pigmentation over 6 months (ScienceDirect, 2025).
- Panfacial Rejuvenation: Case series using dilutions from 1:1 to 1:6 showed balanced facial contouring and skin improvement with no adverse events (ASJ Open Forum, 2024).
- Comparative Trials: Radiesse® and Rennova® Diamond Intense both increased dermal thickness and improved skin quality, with similar safety profiles (PMC12193805, 2025).
Safety Profile and Adverse Events
Radiesse® is generally well-tolerated when administered by experienced injectors. Most adverse events are mild and resolve within days to weeks.
| Adverse Event Type | Incidence (%) | Typical Duration | Reference |
|---|---|---|---|
| Swelling/Edema | Up to 99 | Days to weeks | MDPI, 2024 |
| Bruising | 72 | Days | MDPI, 2024 |
| Pain | 92 | Hours to days | MDPI, 2024 |
| Delayed Nodules | 0.85 | Weeks to months | MDPI, 2024 |
| Severe (e.g., necrosis) | 0.27 | Variable | MDPI, 2024 |
Contraindications: Severe allergies, bleeding disorders, or active infections at the injection site.
Precautions: Vascular occlusion risk requires advanced anatomical knowledge and technique.
At Cosmetic Injectables Center Medspa, all procedures are performed by certified injectors under Dr. Soleiman’s direct supervision, with advanced safety protocols and a comprehensive Good Faith Exam for every patient.
Radiesse® vs. Other Injectable Fillers
| Feature | Radiesse® (CaHA) | Sculptra® (PLLA) | Hyaluronic Acid (e.g., Juvederm®, Restylane®) |
|---|---|---|---|
| Main Action | Collagen stimulation + immediate volume | Collagen stimulation (delayed) | Immediate volume (minimal biostimulation) |
| Longevity | 12–18 months | 18–24 months | 6–18 months |
| FDA Approvals | Wrinkles, HIV lipoatrophy, hands | Wrinkles, HIV lipoatrophy | Wrinkles, lips, cheeks, under eyes, etc. |
| Onset of Results | Immediate + progressive | Gradual (weeks) | Immediate |
| Viscosity | High (structural support) | Moderate | Variable (depends on product) |
| Biostimulation | Collagen, elastin, angiogenesis | Collagen | Minimal |
| Common Uses | Midface, jawline, hands, neck, décolletage | Cheeks, temples, facial volume | Lips, cheeks, nasolabial folds, under eyes |
| Reversibility | Not reversible | Not reversible | Reversible with hyaluronidase |
| Typical Adverse Events | Swelling, bruising, rare nodules | Swelling, nodules, rare granulomas | Swelling, bruising, rare Tyndall effect |
For more on alternative fillers, see Sculptra, Juvederm Fillers, and Restylane Fillers.
Procedure Options and Customization
Undiluted Radiesse®
- Used for deep structural support (e.g., cheeks, jawline).
- Provides immediate lift and contour.
Hyperdiluted Radiesse®
- Mixed with saline/lidocaine (1:3 to 1:6) for superficial injection.
- Targets skin quality, fine lines, and laxity in neck, décolletage, and hands.
- Supported by consensus guidelines (PRS Global Open, 2019).
Combination Approaches
- Layered with hyaluronic acid fillers for comprehensive rejuvenation.
- Used in panfacial protocols for balanced, natural results.
Treatment Areas
Scientific and Regulatory Foundations
- Histology: CaHA induces robust collagen and elastin formation, with low risk of chronic inflammation (Frontiers in Medicine, 2023).
- FDA Approvals: Established safety and efficacy for facial wrinkles, HIV lipoatrophy, and hand augmentation (FDA Summary, 2015).
- Consensus Guidelines: Hyperdiluted CaHA protocols for skin tightening are widely adopted in expert practice (PRS Global Open, 2019).
Why Choose Cosmetic Injectables Center Medspa for Radiesse®?
- Physician-led care: Dr. Sherly Soleiman, MD, is a board-certified physician, national trainer, and clinical trial investigator for injectable fillers.
- Certified expert injectors: All treatments are performed by highly experienced, certified providers under direct medical supervision.
- Safety and transparency: Every patient receives a comprehensive Good Faith Exam and full informed consent.
- Natural results: A conservative, artistic approach ensures subtle, proportional outcomes.
- Top 1% Allergan status: National recognition for expertise and volume in medical aesthetics.
Frequently Asked Questions
What is Radiesse® made of?
Radiesse® contains calcium hydroxylapatite microspheres suspended in a carboxymethylcellulose gel carrier, providing both immediate volume and long-term collagen stimulation.
How long do Radiesse® results last?
Results typically last 12–18 months, with some patients experiencing benefits beyond this period due to ongoing collagen production. Individual results may vary.
Is Radiesse® safe?
When administered by certified injectors, Radiesse® has a strong safety profile. Most side effects are mild and temporary, such as swelling or bruising.
What areas can be treated with Radiesse®?
Common areas include cheeks, jawline, nasolabial folds, hands, neck, and décolletage. Hyperdiluted Radiesse® is used for skin quality improvement in larger areas.
How does Radiesse® compare to hyaluronic acid fillers?
Radiesse® provides both immediate volume and long-term collagen stimulation, while hyaluronic acid fillers offer reversible, immediate volume with minimal biostimulation.
Can Radiesse® be reversed?
Radiesse® is not reversible. It gradually breaks down over time as the body absorbs the microspheres and newly formed collagen remains.
What are the risks of Radiesse®?
Risks include swelling, bruising, pain, and rare complications like nodules or vascular occlusion. Severe events are rare when performed by skilled injectors.
Is Radiesse® FDA-approved?
Yes, Radiesse® is FDA-approved for facial wrinkles, HIV-associated lipoatrophy, and hand augmentation.
Who should not receive Radiesse®?
Individuals with severe allergies, bleeding disorders, or active infections at the injection site should avoid Radiesse®.
How do I know if Radiesse® is right for me?
A consultation with a certified expert injector at Cosmetic Injectables Center Medspa will determine the best approach based on your goals and medical history.
This article is medically reviewed by Dr. Sherly Soleiman, MD, board-certified physician and national trainer in nonsurgical medical aesthetics at Cosmetic Injectables Center Medspa, Sherman Oaks, CA.